core competences for the physical activity and exercise component

BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION AND REHABILITATION

The British Association for Cardiovascular Prevention and Rehabilitation is an affiliated group of the

The Seven Core Components for Cardiovascular Disease

Prevention and Rehabilitation

British Association for Cardiovascular Prevention and Rehabilitation Exercise Professionals Group

SUMMER

LONG-TERM M

AN

AG

EM

EN

T

AU D IT A N D E VA L U AT ION

Psychosocial

health

Life

style

risk

factor

man

ag

ement

therapiesmanagem

ent

Card

ioprotective risk fa

ctor

Medical

Health behaviour

change and education

Core Competences for the Physical Activity and Exercise Component for Cardiovascular Disease Prevention and Rehabilitation Services

Contents

Introduction 1

A guide to using this document 3

The Competences 5

Competency 1: Core knowledge 5

Competency 2: Professional behaviour 8

Competency 3: Communication 12

Competency 4: Prepare, adapt and restore the environment and equipment

14

Competency 5: Preparing the individual for supervised exercise 16

Competency 6: Assessment 18

Competency 7: Physical activity planning and exercise prescription

21

Competency 8: Lead and/or deliver the supervised exercise session

23

Competency 9: Forward planning 26

Competency 10: Managing the unwell individual 28

Competency 11: Educational materials 30

Competency 12: Service planning and management 32

Competency 13: Service evaluation 35

Glossary 37

Acknowledgements 39

References 40

This document is the intellectual property of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR).

Standards and Core Components 2012 (2nd Edition) 1

Introduction

This competency document has been compiled to complement the following:

i. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Position Statement 2010 Update: Core competencies for cardiac rehabilitation/secondary prevention professionals .

ii. The British Association for Cardiac Prevention and Rehabilitation (BACPR) Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation 2012 .

iii. The BACPR-Exercise Professional Group (BACPR-EPG) Position Statement (2012) Essential competences and minimum qualifications required to lead the exercise component in early cardiac rehabilitation.

The BACPR has launched the second edition of the BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation (March 2012). The seven core components include Physical Activity and Exercise as part of Lifestyle Risk Factor Management for which staff leading the exercise component of cardiac rehabilitation (CR) should be appropriately qualified, skilled and competent.

The BACPR-EPG has produced a Position Statement which outlines the essential competences and minimum qualifications required to lead the supervised exercise component in early cardiac rehabilitation. Having established the Position Statement, a working party representing the Exercise Professionals of the BACPR has now completed a supporting document which provides a framework that encompasses the knowledge, skills and competences of all professional groups involved in delivery of the exercise and physical activity component within CR. It is envisaged that this document will inform national practice and enable service providers and managers to ensure appropriate governance and safe and effective service delivery. In addition, it can be used as a useful tool to advise employers on standardised recruitment, giving a clear picture of the definition of a suitably qualified practitioner.

Competent health and exercise professionals are essential to the successful delivery of a CR service which meets the needs of the patient whilst promoting high quality CR services. This document provides guidance on the key competences required to ensure the use of best practice standards and guidelines for physical activity and exercise prescription. In total, 13 core competences are outlined, identifying specific knowledge and skills for each core competency and a framework to assess the health professional’s ability to demonstrate their competency. This document also serves as a tool to monitor the need for continuing professional development for the exercise professional and supporting staff to achieve specific competences.

2 British Association for Cardiovascular Prevention and Rehabilitation

BACPR Education coordinates the Specialist Level 4 Exercise Instructor qualification and a range of short courses for health and exercise professionals involved in cardiovascular prevention and rehabilitation. To support potential staff training and professional development needs, the competences are aligned to the BACPR’s Education and Training courses. For further information visit the website: http://www.bacpr.com/education

The working party to develop these competences, representing the Exercise Professionals within CR included:

• Association of Chartered Physiotherapists with a special interest in Cardiac Rehabilitation (ACPICR), who produced ‘Core Competences for the exercise component of Phase III’ in 2005, revised 2008.

• BACPR Exercise Instructor Network (EIN)

• British Association of Sport and Exercise Sciences (BASES)

All three representative organisations agreed to work together to produce one single document outlining the competences required for the physical activity and exercise component of the patient’s journey through cardiac rehabilitation.


A guide to using this document

1. As part of the development process for this competency framework various documents were utilised by the working group in the early scoping period. Our thanks have been expressed to the organisations responsible for the development/publishing of these documents which included:

a) ACPICR Competences for the Exercise Component of the Phase III Cardiac Rehabilitation (2008)

b) BACPR EPG Position statement (2012)

c) BACPR Standards and Core Components for CR (2007, 2nd edition 2012)

d) British Association of Sport and Exercise Sciences Accreditation Competency Profile (2009)

e) Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. 31(1):2-10. Hamm LF, Sanderson BK, Ades PA et al. (2011)

f) Position Statement of the AACVPR Core Competencies for CR /secondary prevention professionals (2010)

g) Skills for Health National Occupational Standards

h) Skills Active National Occupational Standards (2010):

i) Level 4 Unit D518

ii) Level 3 Unit D463

iii) Level 3 Unit D464

iv) Other (no specified level): Full suite of Sports and Exercise Science

i) Wellbeing South East Exercise Referral Accreditation System “Recognising Excellence” (2010)

2. Each competency is laid out in a table format so that the responses can be recorded easily and can be completed either electronically or on a hard copy.

3. Within each competency, there is a series of numbered performance criteria (pc) and columns against which to record:

a) The date the pc is achieved.

b) Whether the pc is essential, desirable or not applicable (E, D, N/A respectively).

c) Comments to identify perhaps, where further professional development is required to achieve the pc or to record specific exemplary areas of performance.

4. At the end of each competency there is a summary table which records:

a) A summary of performance observed: achieved/improvement required with comments/actions as appropriate.

b) Signatures of the reviewee and the reviewer to validate the recorded response and agreed outcomes.


5. Evidence to determine success of a staff member to fulfil the criteria can be achieved through various methods, e.g.:

a) Practical observation

b) Verbal communication

c) Questioning

d) In-service training

e) Mandatory training

f) External courses

g) Other resources, e.g. BACPR and ACPICR standards.

6. It is not intended that observation and/or achievement of these competences should be a time consuming exercise. It is therefore recommended that reviewers and reviewees consider this document as a useful tool to monitor performance and subsequent professional development required over a period of time (to be defined internally) rather than a lengthy process that is time consuming and impacts negatively on service delivery.

7. As the document relates to the competences required for delivery of physical activity and exercise provision across the patient’s journey through CR, not all competences will be relevant to each member of staff. Hence, not all 13 competences and relating pc need to be achieved.

8. It is the responsibility of the Manager/Reviewer to determine if the competency or pc is essential, desirable and/or relevant to the member of staff.

9. Each competency is also mapped against BACPR Education and Training courses to identify appropriate training for the reviewee if applicable.

10. The competences can be linked with the NHS Agenda for Change Knowledge and Skills Framework (KSF) and therefore used as evidence for the KSF.

11. The reviewer ideally should be competent in assessing an individual’s ability according to the competences outlined and have a sound understanding of the skills required to deliver safe and effective physical activity and exercise prescription in CR. It is recommended however, that a reviewer holds a relevant assessor qualification to enable objective assessment of the reviewee’s knowledge and ability.

12. After successful completion of the competences, it is recommended that the competences will be reviewed as part of an annual appraisal to ensure competency is maintained, or in response to new published evidence and/or changes to national or local guidance.


Com

pete

ncy

1:

Core

know

ledge

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

In r

elat

ion

to p

hysi

cal a

ctiv

ity a

nd e

xerc

ise,

the

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

know

ledg

e an

d un

ders

tand

ing

of:

1.1

Car

diov

ascu

lar:

• A

nato

my

• P

hysi

olog

y

1.2

Pro

cess

of a

rter

iosc

lero

sis

and

path

ogen

esis

of

card

iova

scul

ar r

isk

fact

ors.

1.3

Pat

hoph

ysio

logy

of c

ardi

ovas

cula

r co

nditi

ons

and

rela

ted

sign

s an

d sy

mpt

oms.

1.4

Car

diov

ascu

lar

asse

ssm

ents

, dia

gnos

tic

test

s, in

terv

entio

ns a

nd m

edic

al a

nd s

urgi

cal

man

agem

ent.

1.5

Tim

esca

les

for

reco

very

afte

r a

new

car

diac

di

agno

sis

or e

vent

.

1.6

Car

diac

arr

hyth

mia

s (e

.g. c

ompl

ex P

VC

s, a

tria

l fib

rilla

tion,

SV

T) a

nd t

heir

influ

ence

on

phys

ical

ac

tivity

and

sym

ptom

s.

1.7

Ben

efici

al e

ffect

s an

d po

tent

ial r

isks

of p

hysi

cal

activ

ity a

nd e

xerc

ise

on C

VD

.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 1: Core knowledge


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

1.8

Phy

siol

ogic

al r

espo

nses

(nor

mal

and

abn

orm

al) t

o ac

ute

exer

cise

and

ada

ptat

ions

to

chro

nic

exer

cise

.

1.9

Ris

k st

ratifi

catio

n ac

cord

ing

to a

sses

smen

t of

the

in

divi

dual

.

1.10

Sub

max

imal

func

tiona

l cap

acity

tes

ting.

1.11

Exe

rcis

e pr

escr

iptio

n m

etho

dolo

gy fo

r ca

rdio

vasc

ular

end

uran

ce e

xerc

ise

and

resi

stan

ce

trai

ning

in p

atie

nts

with

hea

rt d

isea

se.

1.12

Abs

olut

e an

d re

lativ

e co

ntra

indi

catio

ns t

o ex

erci

se

and

indi

catio

ns t

o te

rmin

ate

an e

xerc

ise

sess

ion.

1.13

Co-

mor

bidi

ties,

lim

iting

or

othe

rwis

e th

at m

ay

influ

ence

an

indi

vidu

al’s

abi

lity

to e

xerc

ise

or

unde

rtak

e ph

ysic

al a

ctiv

ity.

1.14

Cur

rent

rec

omm

enda

tions

(FIT

T) fo

r ex

erci

se a

nd

phys

ical

act

ivity

for

indi

vidu

als

with

CV

D.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

1.15

Met

abol

ic r

equi

rem

ents

for

recr

eatio

nal,

occu

patio

nal,

and

sexu

al a

ctiv

ities

.

1.16

Pha

rmac

olog

ic t

hera

py fo

r C

VD

and

ris

k fa

ctor

m

anag

emen

t.

1.17

Effe

ctiv

e be

havi

our

chan

ge s

trat

egie

s ba

sed

on

com

mon

the

oret

ical

mod

els

and

adul

t le

arni

ng

stra

tegi

es.

1.18

Rel

evan

t na

tiona

l sta

ndar

ds, p

olic

ies

and

guid

elin

es.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i) B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g; (i

i) P

hysi

cal A

ctiv

ity &

Exe

rcis

e in

the

Man

agem

ent

of C

VD

Par

t 1:

Prin

cipl

es &

Pra

ctic

aliti

es &

Par

t II:

Adv

ance

d A

pplic

atio

n; (i

ii) A

sses

sing

Fun

ctio

nal C

apac

ity;

(iv) A

dapt

ing

Exer

cise

; (v

) Mon

itorin

g Ex

erci

se In

tens

ity



Com

pete

ncy

2:

Pro

fess

ional

behavi

our

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal i

s ab

le to

dem

onst

rate

adh

eren

ce to

the

high

est s

tand

ard

of e

thic

al a

nd p

rofe

ssio

nal b

ehav

iour

and

has

dem

onst

rate

d th

e ab

ility

to:

2.1

Gen

eral

Sho

w e

vide

nce

of:

• cu

rren

t pr

ofes

sion

al b

ody

regi

stra

tion

• ap

prop

riate

liab

ility

and

inde

mni

ty in

sura

nce

• C

RB

cle

aran

ce o

r eq

uiva

lent

• co

ntin

uing

pro

fess

iona

l dev

elop

men

t in

clud

ing

reva

lidat

ion

• pr

actic

e w

ithin

lega

l and

eth

ical

bou

ndar

ies

• de

liver

ser

vice

s w

hich

com

ply

with

the

ir pr

ofes

sion

al c

ode

of c

ondu

ct &

rel

evan

t m

edic

o-le

gal r

equi

rem

ents

• w

ork

in a

ccor

danc

e w

ith e

vide

nce

base

d pr

actic

e an

d re

cogn

ised

bes

t pr

actic

e

2.2

Eq

ualit

y an

d d

iver

sity

• E

nsur

e pr

actic

e in

a n

on-d

iscr

imin

ator

y m

anne

r (in

line

with

the

Equ

ality

Act

, 201

0).

• B

e re

spec

tful o

f ind

ivid

uals

and

of t

heir

right

s, r

ecog

nisi

ng p

hysi

cal,

psyc

holo

gica

l, en

viro

nmen

tal,

cultu

ral a

nd s

ocio

-eco

nom

ic

diffe

renc

es, a

dopt

ing

good

pra

ctic

e in

ch

alle

ngin

g di

scrim

inat

ion

and

unfa

irnes

s.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 2: Professional behaviour


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

2.3

Co

nfid

entia

lity

and

rec

ord

kee

pin

g

• D

emon

stra

te c

ompl

ianc

e w

ith t

he D

ata

Pro

tect

ion

Act

, Inf

orm

atio

n G

over

nanc

e an

d C

aldi

cott

prin

cipl

es.

• P

rovi

de e

vide

nce

of c

ompr

ehen

sive

and

acc

urat

e re

cord

kee

ping

in li

ne w

ith lo

cal p

roto

cols

as

appr

opria

te.

2.4

Info

rmed

co

nsen

t

• U

nder

stan

d th

e im

port

ance

of,

and

be a

ble

to

obta

in in

form

ed c

onse

nt a

nd b

e co

mpl

iant

with

lo

cal a

nd n

atio

nal p

olic

ies.

2.5

Dut

y o

f ca

re

• E

xerc

ise

the

prof

essi

onal

dut

y of

car

e an

d to

act

in

the

bes

t in

tere

sts

of t

he in

divi

dual

at

all t

imes

.

• E

nsur

e th

e in

divi

dual

’s p

rivac

y, d

igni

ty, w

ishe

s an

d be

liefs

are

res

pect

ed, w

hils

t m

inim

isin

g an

y un

nece

ssar

y di

scom

fort

.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

2.6

Wo

rkin

g r

elat

ions

hip

s

Con

duct

pro

fess

iona

l wor

king

rel

atio

nshi

ps w

ith in

divi

dual

s,

sign

ifica

nt o

ther

s, c

olle

ague

s an

d pa

rtner

s /

stak

ehol

ders

, to

ensu

re:

• ho

nest

y

• ac

cura

cy

• co

-ope

ratio

n

• av

oida

nce

of m

isre

pres

enta

tion

• av

oida

nce

of a

ny c

onfli

ct o

f int

eres

t

• in

tegr

ity a

nd h

igh

stan

dard

s of

pro

fess

iona

l con

duct

ens

urin

g av

oida

nce

of a

ny in

appr

opria

te b

ehav

iour

• w

ork

is w

ithin

you

r ow

n sc

ope

of p

ract

ice

and

expe

rtis

e, a

nd if

no

t, yo

u se

ek a

dvic

e or

ref

er t

o an

othe

r pr

ofes

sion

al

• pr

ofes

sion

al b

ound

arie

s an

d st

anda

rds

of o

ther

s ar

e re

spec

ted

• de

velo

pmen

t of

the

kno

wle

dge

and

prac

tice

of o

ther

s

• m

ento

r su

ppor

t fo

r co

lleag

ues

is p

rovi

ded

• yo

u ac

t as

a g

ood

role

mod

el

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

2.7

Hea

lth a

nd s

afet

y

Be

awar

e of

and

com

plia

nt w

ith, a

pplic

able

hea

lth a

nd s

afet

y le

gisl

atio

n, in

clud

ing

inci

dent

rep

ortin

g an

d be

abl

e to

act

ac

cord

ingl

y.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i)

B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g;

(ii) B

AC

PR

Sta

ndar

ds a

nd C

ore

Com

pone

nt S

tudy

Day



Com

pete

ncy

3:

Com

munic

ati

on

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal i

s ab

le to

com

mun

icat

e ef

fect

ivel

y w

ith th

e in

divi

dual

, rel

ativ

es, c

arer

s &

pro

fess

iona

l oth

ers,

and

has

dem

onst

rate

d th

e ab

ility

to:

3.1

Com

mun

icat

e ef

fect

ivel

y in

con

side

ratio

n of

in

divi

dual

diff

eren

ces:

cul

ture

, age

, eth

nici

ty,

gend

er, r

elig

ious

bel

iefs

, soc

io-e

cono

mic

sta

tus,

ph

ysic

al, e

mot

iona

l, ps

ycho

logi

cal,

educ

atio

nal a

nd

envi

ronm

enta

l fac

tors

.

3.2

Use

inte

rper

sona

l ski

lls a

nd a

ctiv

e lis

teni

ng

tech

niqu

es t

o en

cour

age

unde

rsta

ndin

g,

coop

erat

ion,

info

rmed

dec

isio

n-m

akin

g an

d ac

tive

enga

gem

ent

with

indi

vidu

als.

3.3

Sel

ect,

use

and

adap

t co

mm

unic

atio

n m

etho

ds

in a

form

at a

nd a

t a

leve

l tha

t is

bas

ed u

pon

the

indi

vidu

al /

gro

up n

eeds

and

abi

litie

s (e

.g. v

erba

l an

d no

n-ve

rbal

).

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 3: Communication


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

3.4

Sho

w s

ensi

tivity

and

em

path

y w

hen

resp

ondi

ng

in a

non

judg

emen

tal m

anne

r, t

o co

ncer

ns a

nd

ques

tions

rai

sed

by in

divi

dual

s, g

ivin

g cl

ear,

co

ncis

e an

d ac

cura

te in

form

atio

n (v

erba

l and

w

ritte

n).

3.5

Est

ablis

h an

d m

aint

ain

effe

ctiv

e co

mm

unic

atio

n w

ith a

nd b

etw

een

team

mem

bers

, hea

lth c

are

prof

essi

onal

s an

d pa

rtne

rs /

sta

keho

lder

s, e

xplo

ring

diffe

ring

pers

pect

ives

to

reac

h co

nsen

sus

on

requ

ired

futu

re a

ctio

n.

3.6

Pro

vide

tim

ely

and

accu

rate

rep

orts

and

han

dove

rs

(com

mun

icat

ing

curr

ent

stat

us, p

rogr

ess

and

phys

ical

act

ivity

/ e

xerc

ise

outc

omes

) to

ensu

re

seam

less

tra

nsiti

on b

etw

een

agen

cies

/ s

ervi

ce

prov

ider

s.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g

Competency 3: Communication


Com

pete

ncy

4:

Pre

pare

, adapt

and r

est

ore

the e

nvi

ron

men

t an

d e

qu

ipm

en

t

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

4.1

App

ly n

atio

nal h

ealth

& s

afet

y gu

idel

ines

and

loca

l op

erat

iona

l pol

icie

s w

hen

cond

uctin

g en

viro

nmen

tal

heal

th a

nd s

afet

y as

sess

men

ts.

4.2

Iden

tify

pote

ntia

l ris

ks a

nd m

inim

ise

any

resu

lting

ha

zard

s in

the

env

ironm

ent

whe

re t

he s

essi

on

will

take

pla

ce, e

.g. i

nade

quat

e he

atin

g, li

ghtin

g,

vent

ilatio

n, h

umid

ity.

4.3

Ens

ure

that

any

nec

essa

ry e

quip

men

t, fu

rnitu

re

or r

esou

rces

are

pre

pare

d, a

vaila

ble,

in a

fit

stat

e an

d re

ady

for

use,

and

if n

ot, t

ake

any

nece

ssar

y re

med

ial a

ctio

n.

4.4

Follo

w t

he c

orre

ct p

roce

dure

s an

d pr

otoc

ols

to

repo

rt a

nd r

ecor

d pr

oble

ms

with

the

env

ironm

ent,

equi

pmen

t an

d m

ater

ials

.

4.5

Ens

ure

avai

labi

lity

of a

ppro

pria

te r

esus

cita

tion

equi

pmen

t w

hich

is c

heck

ed a

nd r

eady

for

use.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

4.6

Ada

pt e

xerc

ise

equi

pmen

t an

d th

e en

viro

nmen

t du

ring

exer

cise

ses

sion

s as

app

ropr

iate

4.7

Mov

e an

d ha

ndle

equ

ipm

ent

and

reso

urce

s in

an

appr

opria

te, s

afe

man

ner

whi

ch is

con

sist

ent

with

cu

rren

t le

gal a

nd o

rgan

isat

iona

l req

uire

men

ts.

4.8

Ret

urn

equi

pmen

t, fu

rnitu

re a

nd r

esou

rces

to

the

corr

ect

loca

tion

for

stor

age

or t

rans

port

atio

n af

ter

use

and

leav

e th

e en

viro

nmen

t in

a c

ondi

tion

suita

ble

for

futu

re u

se.

4.9

Ens

ure

com

plia

nce

to c

urre

nt o

rgan

isat

iona

l in

fect

ion

cont

rol r

equi

rem

ents

.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

BA

CP

R L

evel

4 E

xerc

ise

Inst

ruct

or T

rain

ing



Com

pete

ncy

5:

Pre

pari

ng t

he i

ndiv

idual

for

superv

ised

exe

rcis

e

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

5.1

Ens

ure

the

indi

vidu

al u

nder

stan

ds t

he p

urpo

se,

stru

ctur

e, p

roce

dure

s an

d ob

ject

ives

of t

he s

essi

on

and

how

the

se li

nk t

o th

eir

goal

s.

5.2

Iden

tify

and

resp

ond

to a

ny in

form

atio

n ab

out

the

indi

vidu

al’s

res

pons

e to

the

pre

viou

s se

ssio

n or

any

ch

ange

in p

hysi

cal c

ondi

tion,

thr

ough

pre

-exe

rcis

e sc

reen

ing

and

appr

opria

te u

se o

f clin

ical

mea

sure

s.

5.3

Neg

otia

te, a

gree

and

rec

ord

with

the

indi

vidu

al a

ny

chan

ges

to t

he p

lann

ed a

ctiv

ities

.

5.4

Ens

ure

indi

vidu

als

have

all

nece

ssar

y m

edic

atio

n pl

us b

lood

glu

cose

man

agem

ent

requ

irem

ents

as

appr

opria

te.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 5: Preparing the individual for supervised exercise


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

5.5

Rei

nfor

ce t

he r

atio

nale

for

a sa

fe a

nd e

ffect

ive

exer

cise

ses

sion

and

the

way

in w

hich

thi

s ca

n be

ac

hiev

ed.

5.6

Ens

ure

indi

vidu

als

are

appr

opria

tely

dre

ssed

an

d eq

uipp

ed fo

r ex

erci

se, e

.g. f

ootw

ear,

loos

e co

mfo

rtab

le c

loth

ing,

hea

rt r

ate

mon

itor

if re

quire

d.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i)

BA

CP

R L

evel

4 E

xerc

ise

Inst

ruct

or T

rain

ing;

(ii

) Phy

sica

l Act

ivity

& E

xerc

ise

in t

he M

anag

emen

t of

CV

D P

art

I: A

dvan

ced

App

licat

ion.

Competency 5: Preparing the individual for supervised exercise


Com

pete

ncy

6:

Ass

ess

ment

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as t

he a

bilit

y to

ass

ess

the

indi

vidu

al’s

nee

ds a

nd a

bilit

ies

befo

re p

lann

ing

exer

cise

and

phy

sica

l act

ivity

, and

can

de

mon

stra

te t

he a

bilit

y to

:

6.1

Obt

ain

an a

ppro

ved

refe

rral

doc

umen

t co

ntai

ning

su

ffici

ent

and

mea

ning

ful i

nfor

mat

ion.

6.2

Col

late

and

inte

rpre

t in

form

atio

n pr

ior

to t

he

asse

ssm

ent.

6.3

Wel

com

e th

e in

divi

dual

and

exp

lain

the

ass

essm

ent

proc

ess.

6.4

Asc

erta

in:

• re

leva

nt p

ast

med

ical

his

tory

• pa

st a

nd c

urre

nt c

ardi

ac s

tatu

s

• co

-mor

bidi

ties

and

func

tiona

l im

pairm

ent

• cu

rren

t sy

mpt

oms

6.5

Iden

tify

inap

prop

riate

ref

erra

ls in

clud

ing

cons

ider

atio

n of

any

abs

olut

e /

rela

tive

cont

rain

dica

tions

to

exer

cise

(in

line

with

BA

CP

R

guid

elin

es) a

nd d

eal w

ith t

hese

acc

ordi

ng t

o lo

cal

proc

edur

e.

6.6

Iden

tify

curr

ent

med

icat

ions

and

the

impl

icat

ions

for

phys

ical

act

ivity

/ e

xerc

ise.

6.7

Asc

erta

in p

revi

ous

and

curr

ent

leve

ls o

f phy

sica

l ac

tivity

/ e

xerc

ise

thro

ugh

disc

ussi

on a

nd u

sing

ap

prop

riate

val

idat

ed t

ools

.

6.8

Ass

ess

the

indi

vidu

al’s

rea

dine

ss t

o pa

rtic

ipat

e:

adop

t ap

prop

riate

beh

avio

ural

cha

nge

stra

tegi

es

and

mot

ivat

iona

l int

ervi

ewin

g te

chni

ques

to

esta

blis

h an

d ag

ree

phys

ical

act

ivity

/ e

xerc

ise

shor

t an

d lo

ng t

erm

goa

ls.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 6: Assessment


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

6.9

Con

duct

and

rec

ord

appr

opria

te s

eria

l m

easu

rem

ents

of:

• bl

ood

pres

sure

(aut

omat

ed a

nd m

anua

l)

• he

art

rate

(pal

patio

n an

d he

art

rate

mon

itorin

g de

vice

s)

• R

PE

• B

lood

glu

cose

• P

ulse

oxi

met

ry

6.10

Con

duct

and

rec

ord

an E

CG

in li

ne w

ith a

vaila

ble

equi

pmen

t

6.11

Und

erta

ke c

ompr

ehen

sive

ris

k st

ratifi

catio

n fo

r ex

erci

se in

line

with

rec

ogni

sed

guid

elin

es (e

.g.

BA

CP

R a

nd A

AC

VP

R g

uide

lines

).

6.12

Sel

ect

and

cond

uct

an a

ppro

pria

te s

ub-m

axim

al

func

tiona

l cap

acity

ass

essm

ent,

in li

ne w

ith

prot

ocol

s:

• C

hest

er s

tep

test

• In

crem

enta

l Shu

ttle

Wal

k Te

st

• C

ycle

erg

omet

er t

est

• 6

min

wal

k te

st

• O

ther

:

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

6.13

Crit

ical

ly e

valu

ate

the

info

rmat

ion

colle

cted

to

dete

rmin

e:

• ph

ysic

al a

ctiv

ity p

lan

• ex

erci

se p

resc

riptio

n

6.14

Ens

ure

the

time

take

n to

con

duct

the

ass

essm

ent

refle

cts

the

proc

ess

and

info

rmat

ion

to b

e co

llect

ed.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i) B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g;

(ii) A

sses

sing

Fun

ctio

nal C

apac

ity;

(iii)

Mon

itorin

g Ex

erci

se In

tens

ity



Com

pete

ncy

7:

Phys

ical

acti

vity

pla

nnin

g a

nd e

xerc

ise p

resc

rip

tion

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

7.1

Agr

ee a

n in

divi

dual

ised

phy

sica

l act

ivity

pla

n w

ith

SM

AR

T go

als

incl

udin

g ac

tiviti

es o

f dai

ly li

ving

and

a

hom

e /

unsu

perv

ised

pro

gram

me.

7.2

Pre

scrib

e an

d ad

apt

safe

and

effe

ctiv

e ex

erci

se

appr

opria

te t

o th

e in

divi

dual

’s n

eeds

in li

ne w

ith

guid

elin

es a

nd t

he F

ITT

prin

cipl

e fo

r:

• w

arm

up

and

cool

dow

n

• ca

rdio

vasc

ular

end

uran

ce e

xerc

ise

• re

sist

ance

exe

rcis

e

• fle

xibi

lity

• ot

her

e.g.

bal

ance

, coo

rdin

atio

n

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

7.3

Use

obj

ectiv

e ph

ysio

logi

cal m

easu

res

to in

form

in

divi

dual

ised

exe

rcis

e pr

escr

iptio

n, e

.g. M

ETs

, HR

, R

PE

.

7.4

Enc

oura

ge e

ffect

ive

use

of a

ppro

pria

te r

esou

rces

to

hel

p th

e in

divi

dual

ach

ieve

agr

eed

goal

s an

d ob

ject

ives

, e.g

. sel

f hel

p m

anua

ls, a

ctiv

ity d

iarie

s et

c.

7.5

Edu

cate

and

sup

port

indi

vidu

als

on s

afe

and

effe

ctiv

e in

depe

nden

t ph

ysic

al a

ctiv

ity /

exe

rcis

e in

clud

ing

appr

opria

te w

arm

up

and

cool

dow

n,

sign

s an

d sy

mpt

oms

of o

ver-

exer

tion

or u

nder

-ac

hiev

emen

t an

d ac

tiviti

es t

o av

oid.

7.6

Rev

iew

and

ada

pt t

he p

hysi

cal a

ctiv

ity p

lan

and

exer

cise

pre

scrip

tion

in r

espo

nse

to t

he in

divi

dual

’s

mot

ivat

ion,

nee

ds a

nd a

bilit

y, a

nd p

rogr

ess

/ re

gres

s th

e pr

escr

iptio

n ac

cord

ingl

y.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i) B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g; (i

i) A

sses

sing

Fun

ctio

nal C

apac

ity;

(iv) A

dapt

ing

Exer

cise

; (ii

i) M

onito

ring

Exer

cise

Inte

nsity



Com

pete

ncy

8:

Lead a

nd/o

r deliv

er

the s

uperv

ised

exe

rcis

e s

ess

ion

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

8.1

Teac

h, r

evie

w a

nd a

dapt

indi

vidu

al a

nd g

roup

ex

erci

se in

res

pons

e to

cha

ngin

g ci

rcum

stan

ces

and

indi

vidu

al’s

res

pons

e to

exe

rcis

e.

8.2

Est

ablis

h an

d ju

stify

the

sta

ff /

patie

nt r

atio

bas

ed

on s

uper

visi

on r

equi

rem

ents

and

ris

k st

ratifi

catio

n.

8.3

Util

ise

othe

r m

embe

rs o

f sta

ff ap

prop

riate

ly d

urin

g th

e ex

erci

se s

essi

on t

o en

sure

saf

e an

d ef

fect

ive

clas

s m

anag

emen

t.

8.4

Str

uctu

re a

nd le

ad e

xerc

ise

sess

ions

in li

ne w

ith t

he

FITT

prin

cipl

e ap

prop

riate

to

indi

vidu

al n

eeds

and

fu

nctio

nal a

bilit

ies.

8.5

Pro

vide

indi

vidu

als

with

war

m u

p an

d co

ol-d

own

exer

cise

s th

at a

re a

ppro

pria

te t

o th

eir

clin

ical

sta

tus

and

abilit

y.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

8.6

Pro

vide

a c

ondi

tioni

ng c

ompo

nent

whi

ch is

in

divi

dual

ised

acc

ordi

ng t

o th

e ne

eds

of t

he

indi

vidu

al.

8.7

Pro

vide

inst

ruct

ion,

exp

lana

tions

and

exe

rcis

e de

mon

stra

tions

tha

t ar

e te

chni

cally

cor

rect

and

ap

prop

riate

to

the

indi

vidu

al’s

/ g

roup

’s n

eeds

.

8.8

Mon

itor

the

indi

vidu

al’s

exe

rcis

e pe

rform

ance

by:

• U

sing

sub

ject

ive

(e.g

. RP

E) a

nd o

bjec

tive

(e.g

. H

R, B

P) m

etho

ds t

o ef

fect

ivel

y m

onito

r ex

erci

se

inte

nsity

.

• B

eing

aw

are

of t

he in

divi

dual

’s r

espo

nse

to

exer

cise

and

tak

ing

appr

opria

te a

ctio

n as

re

quire

d.

• D

eter

min

ing

how

and

whe

n to

effe

ctiv

ely

mon

itor

indi

vidu

als.

• O

bser

ving

indi

vidu

als

thro

ugho

ut t

he e

xerc

ise

sess

ion

and

taki

ng a

ppro

pria

te a

ctio

n as

re

quire

d.

• A

dapt

ing

the

mon

itorin

g m

etho

d as

det

erm

ined

by

the

indi

vidu

al’s

pro

gres

s an

d th

eir

unde

rsta

ndin

g of

sel

f-m

onito

ring.

8.9

Effe

ctiv

ely

use

verb

al in

stru

ctio

n, d

emon

stra

tion,

au

dio

and

visu

al c

ues,

and

mot

ivat

iona

l tec

hniq

ues

whe

n de

liver

ing

grou

p ex

erci

se.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

8.10

Obs

erve

and

ana

lyse

indi

vidu

al’s

exe

rcis

e pe

rform

ance

and

cor

rect

the

ir te

chni

que

at

appr

opria

te p

oint

s pr

ovid

ing

posi

tive

rein

forc

emen

t th

roug

hout

.

8.11

Teac

h an

d m

onito

r th

e pe

rform

ance

of a

ll in

divi

dual

s w

ithin

a g

roup

set

ting.

8.12

Pro

vide

indi

vidu

als

with

an

appr

opria

te p

erio

d of

po

st e

xerc

ise

supe

rvis

ion.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i)

BA

CP

R L

evel

4 E

xerc

ise

Inst

ruct

or T

rain

ing;

(ii

) Phy

sica

l Act

ivity

& E

xerc

ise

in t

he M

anag

emen

t of

CV

D P

art

I: A

dvan

ced

App

licat

ion.



Com

pete

ncy

9:

Forw

ard

pla

nnin

g

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal i

s ab

le t

o pl

an fo

r th

e in

divi

dual

’s o

nwar

d jo

urne

y an

d ha

s de

mon

stra

ted

the

abilit

y to

:

9.1

Con

duct

an

appr

opria

te a

sses

smen

t on

com

plet

ion

of t

he p

hysi

cal a

ctiv

ity /

exe

rcis

e pr

ogra

mm

e w

hich

ev

alua

tes

prog

ress

to

date

and

est

ablis

hes

an e

xit

stra

tegy

for

the

indi

vidu

al.

9.2

Pro

vide

info

rmat

ion

on fu

ture

opt

ions

for

cont

inue

d ph

ysic

al a

ctiv

ity in

clud

ing

hom

e ba

sed

exer

cise

and

su

perv

ised

/ u

nsup

ervi

sed

exer

cise

pro

gram

mes

.

9.3

Rei

nfor

ce t

he b

enefi

ts o

f lon

g te

rm r

egul

ar p

hysi

cal

activ

ity /

exe

rcis

e.

9.4

Mak

e tim

ely

onw

ard

refe

rral

to

appr

opria

tely

qu

alifi

ed p

rofe

ssio

nals

usi

ng r

ecog

nise

d lo

cal o

r B

AC

PR

doc

umen

tatio

n.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 9: Forward planning


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal i

s ab

le t

o pl

an fo

r th

e in

divi

dual

’s o

nwar

d jo

urne

y an

d ha

s de

mon

stra

ted

the

abilit

y to

:

9.5

Ena

ble

indi

vidu

als

to c

arry

out

sel

f mon

itorin

g in

or

der

to e

nsur

e sa

fe a

nd e

ffect

ive

phys

ical

act

ivity

/

exer

cise

.

9.6

Tran

sfer

tim

ely

and

accu

rate

info

rmat

ion

to

the

prim

ary

care

tea

m a

nd o

ther

hea

lthca

re

prof

essi

onal

s, a

s ap

prop

riate

.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g.

Competency 9: Forward planning


Com

pete

ncy

10:

Man

agin

g t

he u

nw

ell

indiv

idual

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal i

s ab

le t

o pl

an fo

r th

e in

divi

dual

’s o

nwar

d jo

urne

y an

d ha

s de

mon

stra

ted

the

abilit

y to

:

10.1

Act

in a

cal

m, s

ensi

tive,

effi

cien

t m

anne

r w

hen

deal

ing

with

an

unw

ell i

ndiv

idua

l.

10.2

Use

the

ski

lls a

nd s

uppo

rt o

f col

leag

ues

whe

n m

anag

ing

an u

nwel

l ind

ivid

ual,

be a

ble

to

adap

t yo

ur r

ole

with

in t

he t

eam

in r

espo

nse

to

a de

velo

ping

situ

atio

n an

d en

sure

oth

er g

roup

pa

rtic

ipan

ts a

re m

anag

ed a

ppro

pria

tely

.

10.3

Ass

ess

for

sign

s an

d sy

mpt

oms

whi

ch m

ay in

dica

te

a ch

ange

in c

ardi

ac s

tatu

s an

d ta

ke a

ppro

pria

te

actio

n.

10.4

Rec

ogni

se o

ther

sig

ns a

nd s

ympt

oms

whi

ch

may

indi

cate

a n

ew c

ondi

tion

or a

cha

nge

in a

n un

derly

ing

cond

ition

and

tak

e ap

prop

riate

act

ion.

10.5

Diff

eren

tiate

bet

wee

n ca

rdia

c an

d no

n-ca

rdia

c sy

mpt

oms

and

take

app

ropr

iate

act

ion.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 10: Managing the unwell individual


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

10.6

Dea

l app

ropr

iate

ly w

ith in

divi

dual

s w

ho p

rese

nt w

ith

med

ical

com

plic

atio

ns t

hat

requ

ire in

terv

entio

n bu

t do

not

nec

essa

rily

requ

ire e

xclu

sion

from

exe

rcis

e e.

g. a

ngin

a, h

ypot

ensi

on, h

yper

tens

ion,

poo

r di

abet

ic c

ontr

ol, s

low

or

fast

HR

etc

.

10.7

Des

crib

e th

e lo

cal e

mer

genc

y pr

otoc

ols

for

sum

mon

ing

assi

stan

ce w

hen

an in

divi

dual

be

com

es u

nwel

l.

10.8

Rap

idly

ass

ess

an in

divi

dual

who

has

col

laps

ed a

nd

prov

ide

appr

opria

te t

reat

men

t, as

per

Res

usci

tatio

n C

ounc

il G

uide

lines

, if h

e/sh

e is

:

(a) u

ncon

scio

us b

ut b

reat

hing

nor

mal

ly

(b) u

ncon

scio

us a

nd n

ot b

reat

hing

10.9

Giv

e a

conc

ise

and

accu

rate

han

dove

r to

the

re

leva

nt h

ealth

pro

fess

iona

l and

com

plet

e th

e ap

prop

riate

doc

umen

tatio

n.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i)

BA

CP

R L

evel

4 E

xerc

ise

Inst

ruct

or T

rain

ing;

(ii

) Phy

sica

l Act

ivity

& E

xerc

ise

in t

he M

anag

emen

t of

CV

D P

art

II:

Adv

ance

d A

pplic

atio

n

Competency 10: Managing the unwell individual


Com

pete

ncy

11:

Educati

onal

mate

rials

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

11.1

Und

erst

and

the

need

to

prov

ide

indi

vidu

als

with

th

e in

form

atio

n ne

cess

ary

to e

nabl

e th

em t

o m

ake

info

rmed

dec

isio

ns a

bout

phy

sica

l act

ivity

and

ex

erci

se.

11.2

Pro

vide

rel

evan

t re

sour

ces

rela

ting

to p

hysi

cal

activ

ity a

nd s

uper

vise

d /

unsu

perv

ised

exe

rcis

e as

ap

prop

riate

.

11.3

Kno

w t

he lo

cal a

vaila

bilit

y an

d co

st o

f app

ropr

iate

pu

blic

atio

ns a

nd s

elf h

elp

man

uals

, and

be

able

to

faci

litat

e th

e ef

fect

ive

use

of t

hese

res

ourc

es.

11.4

Pla

n, d

esig

n an

d pr

oduc

e re

sour

ces

to m

eet

a sp

ecifi

c pu

rpos

e, t

akin

g in

to a

ccou

nt t

ime,

mon

ey

and

expe

rtis

e av

aila

ble.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 11: Educational materials


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

11.5

Ens

ure

prom

otio

nal m

ater

ials

are

con

sist

ent

with

ot

her

rela

ted

serv

ices

.

11.6

Eva

luat

e ex

istin

g an

d ne

w m

ater

ial t

o de

term

ine

the

valid

ity, a

ccur

acy,

acc

essi

bilit

y an

d ap

prop

riate

ness

, and

cus

tom

ise

to m

eet

loca

l ne

eds

as r

equi

red.

11.7

Dis

trib

ute

reso

urce

s ef

fect

ivel

y, u

tilis

ing

appr

opria

te

rout

es in

clud

ing

diss

emin

atio

n to

tar

gete

d gr

oups

.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

B

AC

PR

Sta

ndar

ds a

nd C

ore

Com

pone

nts

Stu

dy D

ay

Competency 11: Educational materials


Com

pete

ncy

12:

Serv

ice p

lannin

g a

nd m

anagem

en

t

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

12.1

Agr

ee a

nd e

stab

lish

clea

r se

rvic

e ai

ms

and

obje

ctiv

es w

ith m

easu

rabl

e ou

tcom

es fo

r ph

ysic

al

activ

ity /

exe

rcis

e.

12.2

Pla

n, d

evel

op a

nd im

plem

ent

oper

atio

nal

proc

edur

es a

nd p

roto

cols

for

serv

ice

deliv

ery

incl

udin

g in

clus

ion

and

excl

usio

n cr

iteria

, in

line

with

lo

cal a

nd n

atio

nal g

uide

lines

, cur

rent

evi

denc

e an

d or

gani

satio

nal o

bjec

tives

.

12.3

Dev

elop

, ada

pt a

nd r

egul

arly

rev

iew

pro

toco

ls a

nd

proc

edur

es a

s re

quire

d.

12.4

Dev

elop

, im

plem

ent

and

ensu

re s

yste

ms

are

in

plac

e to

allo

w e

ffect

ive

serv

ice

eval

uatio

n an

d de

velo

pmen

t.

12.5

Be

acco

unta

ble

for

reco

rd k

eepi

ng a

nd

man

agem

ent

in li

ne w

ith c

linic

al a

nd in

form

atio

n go

vern

ance

.

12.6

Eng

age

in e

ffect

ive

part

ners

hip

wor

king

to

prom

ote

qual

ity, c

ontin

uity

of c

are

and

a co

st e

ffect

ive

serv

ice.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 12: Service planning and management


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

12.7

Ens

ure

that

the

ser

vice

pro

mot

es e

qual

ity a

nd

dive

rsity

in a

ccor

danc

e w

ith le

gisl

atio

n, p

olic

ies,

pr

oced

ures

and

rel

evan

t st

anda

rds.

12.8

Be

acco

unta

ble

for

impl

emen

tatio

n of

hea

lth &

sa

fety

legi

slat

ion

and

any

secu

rity

polic

ies

and

proc

edur

es.

12.9

Pro

vide

evi

denc

e of

effe

ctiv

e co

nsul

tatio

n w

ith

serv

ice

user

s w

hen

plan

ning

and

dev

elop

ing

the

serv

ice.

12.1

0P

rovi

de e

vide

nce

of t

he t

eam

’s p

erso

nal a

nd p

ublic

lia

bilit

y an

d in

dem

nity

insu

ranc

e as

app

ropr

iate

.

12.1

1E

nsur

e th

at a

ll pr

ofes

sion

als

deliv

erin

g th

e ex

erci

se

com

pone

nt h

old

the

appr

opria

te q

ualifi

catio

ns,

know

ledg

e an

d sk

ills a

s de

fined

in t

he B

AC

PR

EP

G

Pos

ition

Sta

tem

ent.

12.1

2C

ontr

ibut

e to

the

dev

elop

men

t of

oth

ers

by

faci

litat

ing

a w

ide

rang

e of

CP

D o

ppor

tuni

ties

as

appr

opria

te t

o fu

lfil s

ervi

ce n

eeds

and

obj

ectiv

es.

12.1

3M

anag

e in

divi

dual

per

form

ance

thr

ough

a r

ange

of

rec

ogni

sed

met

hods

in a

ccor

danc

e w

ith lo

cal

polic

y (e

.g. a

ppra

isal

, pee

r re

view

, men

torin

g).

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Competency 12: Service planning and management


No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

12.1

4P

rovi

de e

ffect

ive

wor

kfor

ce p

lann

ing

incl

udin

g re

crui

tmen

t an

d se

lect

ion.

12.1

5Id

entif

y, o

rgan

ise

and

prov

ide

suita

ble

loca

tion(

s)

for

the

serv

ice.

12.1

6P

rovi

de e

ffect

ive

oper

atio

nal m

anag

emen

t of

the

te

am p

riorit

isin

g w

orkl

oad,

ens

urin

g ad

equa

te

staf

fing

leve

ls a

nd s

kill

mix

to

cove

r se

rvic

e pr

ovis

ion.

12.1

7P

rovi

de e

ffect

ive

man

agem

ent

of r

esou

rces

(in

clud

ing

finan

ces

and

educ

atio

nal m

ater

ials

).

12.1

8P

rovi

de u

p to

dat

e co

mpr

ehen

sive

info

rmat

ion

to e

nabl

e th

e te

am t

o ap

prop

riate

ly r

efer

on

/ si

gn-p

ost

to t

ailo

red

phys

ical

act

ivity

/ e

xerc

ise

oppo

rtun

ities

.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

BA

CP

R S

tand

ards

and

Cor

e C

ompo

nent

s S

tudy

Day

Competency 13: Service evaluation


Com

pete

ncy

13:

Serv

ice e

valu

ati

on

No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

The

Car

diac

Reh

abilit

atio

n P

rofe

ssio

nal h

as d

emon

stra

ted

the

abilit

y to

:

13.1

Iden

tify,

dev

elop

and

impl

emen

t ap

prop

riate

m

onito

ring

syst

ems

to e

nabl

e co

mpr

ehen

sive

se

rvic

e ev

alua

tion

of t

he p

hysi

cal a

ctiv

ity /

exe

rcis

e co

mpo

nent

.

13.2

Iden

tify,

dev

elop

and

use

app

ropr

iate

val

id, r

elia

ble

and

cost

effe

ctiv

e qu

antit

ativ

e an

d qu

alita

tive

asse

ssm

ent

tool

s an

d te

chni

ques

to

mea

sure

the

qu

ality

and

val

ue o

f the

phy

sica

l act

ivity

/ e

xerc

ise

inte

rven

tions

.

13.3

Col

lect

& r

ecor

d in

divi

dual

pat

ient

out

com

e m

easu

res

(incl

udin

g sh

ort

and

long

ter

m p

hysi

cal

activ

ity b

ehav

iour

s an

d fu

nctio

nal c

apac

ity) o

n a

card

iac

reha

bilit

atio

n da

taba

se (e

.g. N

AC

R) t

o en

able

loca

l and

nat

iona

l ana

lysi

s.

13.4

Acc

urat

ely

colle

ct a

nd r

ecor

d ke

y se

rvic

e da

ta,

incl

udin

g re

ferr

al in

form

atio

n, u

ptak

e, a

tten

danc

e an

d ad

here

nce

reco

rds.

13.5

Ens

ure

that

the

ser

vice

use

rs h

ave

cont

ribut

ed t

o th

e ev

alua

tion

proc

ess.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le



No

.P

erfo

rman

ce c

rite

ria

Dat

e ac

hiev

edE

,D,N

/A*

Co

mm

ents

13.6

Ana

lyse

loca

l ser

vice

dat

a us

ing

relia

ble

met

hods

to

com

pare

with

rec

ogni

sed

stan

dard

s /

guid

elin

es

and

high

light

the

diff

eren

ces.

13.7

Dra

w v

alid

con

clus

ions

, mak

e re

com

men

datio

ns

base

d on

the

evi

denc

e an

d im

plem

ent

serv

ice

impr

ovem

ent

as a

ppro

pria

te.

13.8

Pre

sent

rel

evan

t in

form

atio

n in

app

ropr

iate

form

ats

(e.g

. rep

orts

) inc

ludi

ng c

urre

nt s

ervi

ce d

eliv

ery

for

Man

ager

s /

Com

mis

sion

ers

/ S

take

hold

ers

to

influ

ence

futu

re s

ervi

ce d

eliv

ery.

* K

ey: E

= E

ssen

tial

D =

Des

irabl

e N

/A =

Not

app

licab

le

Co

mp

eten

cy a

chie

ved

:

Impr

ovem

ent

requ

ired

A

gree

d A

ctio

n

(o

utlin

e as

app

ropr

iate

)D

ate:

Yes

- c

ompe

tenc

y ac

hiev

ed

Com

men

ts:

Dat

e:

Sig

ned

Rev

iew

ee:

Prin

t N

ame:

Sig

ned

Rev

iew

er:

Prin

t N

ame:

Dat

e:

BA

CP

R E

duca

tion

& T

rain

ing

Cou

rse

Ref

eren

ces:

(i) B

AC

PR

Lev

el 4

Exe

rcis

e In

stru

ctor

Tra

inin

g; (i

i) B

AC

PR

Sta

ndar

ds a

nd C

ore

Com

pone

nts

Stu

dy D

ay



Glossary

AACVPR American Association of Cardiovascular and Pulmonary Rehabilitation

ACPICR Association of Chartered Physiotherapists in Cardiac Rehabilitation

BACPR British Association for Cardiovascular Prevention and Rehabilitation

BACPR-EIN British Association for Cardiovascular Prevention and Rehabilitation Exercise Instructor Network

BASES British Association of Sport and Exercise Sciences

CPD Continuing Professional Development

CRB Criminal Records Bureau

CVD Cardiovascular Disease

ECG Electrocardiogram

EPG Exercise Professionals Group – collaboration between the British Association of Sport and Exercise Sciences (BASES), the Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR) and the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) Exercise Instructor Network.

FITT Frequency, Intensity, Time and Type of Exercise

HR Heart Rate

METS Metabolic Equivalent (Task) is a physiological measure expressing the energy cost during a specific physical activity to a reference metabolic rate of 3.5 ml O2·kg−1·min−1 . One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest.

NACR National Audit of Cardiac Rehabilitation – a national dataset and management system

PVC Premature Ventricular Contractions

RPE Rating of Perceived Exertion

SMART Specific, Measurable, Agreed, Realistic, Time bound

SVT Supraventricular Tachycardia

Caldicott Principles These were developed as a result of recommendations in Dame Fiona Caldicott's 1997 report on how patient information was used in the health service. They are a set of six general principles that health and social care organisations should use when reviewing the use of client information.

Cardiac Rehabilitation Professional

Those people who deliver any stage of cardiac rehabilitation who, as part of the service and in the context of these competences, are giving advice and information on physical activity and/or exercise.

Data Protection Act The Data Protection Act 1998 is the main piece of legislation that governs the protection of personal data in the UK. The Act defines eight data protection principles. See http://www.ico.gov.uk/for_organisations/data_protection.aspx for further information.

Equality Act 2010 An Act of Parliament that covers nine protected characteristics, which cannot be used as a reason to treat people unfairly. The Equality Act sets out the different ways in which it is unlawful to treat someone, for example direct and indirect discrimination, harassment, victimisation or failing to make a reasonable adjustment for a disabled person.

Exercise Exercise is a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness. (Caspersen et al 1985)


Exercise Prescription Refers to the design of a plan of fitness-related activities (using FITT principles) specifically for an individual and developed by an exercise professional for a specified purpose.

Exercise Professional An individual, who holds a recognised exercise qualification approved by the Register of Exercise Professionals (REPs), Chartered Society of Physiotherapists (CSP) or the British Association of Sport and Exercise Sciences (BASES), adheres to relevant industry standards and a code of ethics and has the knowledge, skills and competence to perform specific roles in relation to exercise in cardiac rehabilitation.

Health Care Professional An individual, who for the purposes of these competences, provides health services to individuals as part of a cardiovascular prevention and rehabilitation programme.

Individual Those participating in the Cardiac Rehabilitation programme during any stage/phase and covering a broad range of terms including clients, patients, relatives, carers, significant others and service users.

Individualised The ‘tailoring’ of exercise to suit the individual based on clinical and functional needs.

Information Governance Information Governance ensures necessary safeguards for, and appropriate use of, patient and personal information.

Long Term Long term physical activity/exercise management

Outcome Measures Tools that enable the exercise professional to undertake an evaluation of the physical activity and/or exercise component of the cardiac rehabilitation service.

Physical Activity Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure above resting level (Caspersen et al., 1985). This broad definition involves virtually all types of activity like: walking, cycling, dance, traditional games, pastimes, gardening, housework, sports and intentional exercise (Cavill et al., 2006).

UK guidelines (2011): Physical activity includes all forms of activity, such as everyday walking or cycling to get from A to B, active play, work-related activity, active recreation (such as working out in a gym), dancing, gardening or playing active games, as well as organised and competitive sport.

Physical Activity Plan A proposed course of action to support an individual to become more active through both structured and independent physical activity.

Scope of Practice Taking into account legal and ethical responsibilities, work within the boundaries set by an individual’s qualifications, knowledge, skills and experience in order to practice safely and effectively.

Sedentary UK Guidelines (2011): Sedentary behaviour is not simply a lack of physical activity but is a cluster of individual behaviours where sitting or lying is the dominant mode of posture, and energy expenditure is very low.

Short Term Stages 0-6

Supervised Observe and direct the execution of an exercise session

Unsupervised Not supervised or under constant observation


Acknowledgements

Consultation Groups

We acknowledge and thank the following organisations who reviewed this Competency Document as part of the consultation process:

• Association of Chartered Physiotherapists with a special interest in Cardiac Rehabilitation

• British Association for Cardiovascular Prevention and Rehabilitation Exercise Instructor Network

• British Association of Sport and Exercise Sciences

• The British Association for Cardiovascular Prevention and Rehabilitation Council Members

The BACPR EPG Working Group

Acknowledgements for their contribution to the completion of this competency document:

• Gillian Armstrong and Laura Burgess (representing ACPICR)

• Annette Coles and Gordon McGregor (representing BASES)

• Ruth Shaw (representing BACPR Exercise Instructor Network)

• Lesley Simpson (representing BACPR Exercise Instructor Training)

• Annie Holden (Competency Working Group Co-ordinator)


References

Hamm et al (2010). Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update. Position Statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.

The BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation 2012 (2nd Edition)

BACR Exercise Professionals Group (EPG) Position Statement 2012: Essential competences and minimum qualifications required to lead the exercise component in early cardiac rehabilitation.

For more information please visit the BACPR website

www.bacpr.com

BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION AND REHABILITATION

“Promoting excellence in cardiovascular disease prevention and rehabilitation”

The British Association for Cardiovascular Prevention and Rehabilitation

British Cardiovascular Society

9 Fitzroy Square, London, W1T 5HW

Email: [email protected]

Direct Line: +44 (0)20 7380 1919

Fax: +44 (0)20 7388 0903

Website: www.bacpr.com

Registered Charity Number 1135639

Company limited by guarantee. Registered in England 5086964

core competences for the physical activity and exercise component

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